Julie Prusak

Ethos Luxury Travel

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Let's Get Started Planning Your Cruise Vacation!"/>&#13;
		<field type="header" subtype="h2" label="Your Contact Info"/>&#13;
		<field type="text" label="Prefix" name="prefix" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Preferred name" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Preferred Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="What is your preferred method of communication?" inline="true" name="what-is-your-preferred-method-of-communication">&#13;
			<option label="Email" value="email">Email</option>&#13;
			<option label="Phone" value="phone">Phone</option>&#13;
			<option label="Text" value="text">Text</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Travel Style &amp;amp; Preferences"/>&#13;
		<field type="text" label="Is the purpose of this trip to celebrate an occasion?" name="is-the-purpose-of-this-trip-to-celebrate-an-occasion" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Cruise lines you've sailed before?" name="cruise-lines-youve-sailed-before" className="form-control"/>&#13;
		<field type="clientLoyaltyPrograms" label="Loyalty Programs" name="loyalty-program" loyalty-program-note="*** This field allows your client to enter multiple loyalty program numbers (you only need one of these per form template) ***" className="form-control"/>&#13;
		<field type="text" label="How many travelers?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="textarea" required="true" label="Names and relationships of each traveler (for children, please include ages)" placeholder="John (husband)  Jane (wife)  Jim (son - 17)  Jen (daughter - 14)" name="names-and-relationships-of-each-traveler-for-children-please-include-ages" className="form-control"/>&#13;
		<field type="checkbox-group" label="Promotions you qualify for (if available)" name="promotions-you-qualify-for-if-available" other="true">&#13;
			<option label="Senior (55 or older)" value="senior-55-or-older">Senior (55 or older)</option>&#13;
			<option label="Military" value="military">Military</option>&#13;
			<option label="Fire/EMT/Law Enforcement" value="fireemtlaw-enforcement">Fire/EMT/Law Enforcement</option>&#13;
			<option label="Teacher" value="teacher">Teacher</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="What is your budget per individual traveler?" description="This just gives me a general starting point and can always be changed later." name="budget">&#13;
			<option label="$10,000 +" value="10000-">$10,000 +</option>&#13;
			<option label="$5,000 - $9,999" value="5000-9999">$5,000 - $9,999</option>&#13;
			<option label="&lt;$5,000" value="5000">&lt;$5,000</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What activities are you interested in?" description="Check all that apply" name="activity-preferences" other="true">&#13;
			<option label="Culture and history" value="culture-and-history">Culture and history</option>&#13;
			<option label="Whalewatching" value="whalewatching">Whalewatching</option>&#13;
			<option label="Adventure activities" value="adventure">Adventure activities</option>&#13;
			<option label="Food and wine" value="food-and-wine">Food and wine</option>&#13;
			<option label="Shipboard activities" value="shipboard-activities">Shipboard activities</option>&#13;
		</field>&#13;
		<field type="text" label="Anything you absolutely must do or see?" name="must-dos" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="Will you be using an AMEX Platinum or Centurion card (for possible extra amenities)?" name="will-you-be-using-an-amex-platinum-or-centurion-card-for-possible-extra-amenities">&#13;
			<option label="Platinum" value="platinum">Platinum</option>&#13;
			<option label="Centurion" value="centurion">Centurion</option>&#13;
			<option label="other payment option" value="other-payment-option">other payment option</option>&#13;
		</field>&#13;
		<field type="textarea" label="What else would you like me to know?" description="What else would you like me to know about your travelers  budget and/or travel preferences?" name="notes" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Have you worked with a travel advisor before?" name="checkbox-group-1618953940412">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No, this will be the first time" value="no-this-will-be-the-first-time">No, this will be the first time</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="How do you hear about Ethos Luxury Travel?" name="how-do-you-hear-about-ethos-luxury-travel" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Would you like to receive weekly travel inspiration and insider information from Ethos Luxury Travel?" name="would-you-like-to-receive-weekly-travel-inspiration-and-insider-information-from-ethos-luxury-travel">&#13;
			<option label="Yes, sign me up for your informative emails" value="yes-sign-me-up-for-your-informative-emails">Yes, sign me up for your informative emails</option>&#13;
			<option label="Not at this time" value="not-at-this-time">Not at this time</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>